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General NPI Number Information
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NPI Number | 1386118305
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Entity Type | Organization
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Legal Business Name | ERIC L ELLIS MD INC
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Dates
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Enumeration Date | 01/12/2019
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Last Update Date | 03/21/2025
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Provider Practice Location Address
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Address Line | 77 LINCOLN BLVD STE 1
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City | LINCOLN
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State | CA
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Zip | 95648-7422
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Country | US
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Telephone | 916-258-2751
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Fax | 916-258-7172
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Provider Business Mailing Address
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Address Line | 77 LINCOLN BLVD STE 1
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City | LINCOLN
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State | CA
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Zip | 95648-7422
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ERIC LEE ELLIS
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Credential | MD
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Telephone | 916-258-2751
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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